title: Bronchiolitis obliterans syndrome: the Achilles' heel of lung transplantation.
abstract: Lung transplantation is a therapeutic option for patients with end-stage pulmonary disorders. Unfortunately, chronic lung allograft dysfunction (CLAD), most commonly manifest as bronchiolitis obliterans syndrome (BOS), continues to be highly prevalent and is the major limitation to long-term survival. The pathogenesis of BOS is complex and involves alloimmune and nonalloimmune pathways. Clinically, BOS manifests as airway obstruction and dyspnea that are classically progressive and ultimately fatal; however, the course is highly variable, and distinguishable phenotypes may exist. There are few controlled studies assessing treatment efficacy, but only a minority of patients respond to current treatment modalities. Ultimately, preventive strategies may prove more effective at prolonging survival after lung transplantation, but their remains considerable debate and little data regarding the best strategies to prevent BOS. A better understanding of the risk factors and their relationship to the pathological mechanisms of chronic lung allograft rejection should lead to better pharmacological targets to prevent or treat this syndrome.
authors.affiliation: Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, Department of Internal Medicine, The David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California 90095, USA. sweigt@mednet.ucla.edu
authors.forename: S Samuel
authors.initials: SS
authors.lastname: Weigt
authors.forename: Ariss
authors.initials: A
authors.lastname: DerHovanessian
authors.forename: W Dean
authors.initials: WD
authors.lastname: Wallace
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Lynch
authors.forename: John A
authors.initials: JA
authors.lastname: Belperio
mesh_terms: D000402:Airway Obstruction / Q000209:etiology; D000818:Animals; D001989:Bronchiolitis Obliterans / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D018450:Disease Progression; D004417:Dyspnea / Q000209:etiology; D006084:Graft Rejection / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008171:Lung Diseases / Q000503:physiopathology / Q000601:surgery; D016040:Lung Transplantation; D012307:Risk Factors; D013534:Survival